eurecam e-Newsletter
Year 1 Issue 2 June 2010
In this issue:
Useful Links and Important Events
 
 
EURECA-m Board Members

Carmine Zoccali, Italy (EURECAM Chairman)

Adrian Covic, Romania (EURECAM Secretary)
David Goldsmith, UK (Editor in Chief of EURECAM Newsletter)
Gérard Michel London, France (ERA-EDTA President)
Bengt Lindholm, Sweden
Alberto Martinez Castelao, Spain
Gultekin Suleymanlar, Turkey
Danilo Fliser, Germany
Andrzej Wiecek, Poland (liaison with National Societies of Nephrology)
 
Epidemiology and Biostatistics Consultants
Kitty J Jager, The Netherland
Friedo W Dekker, The Netherland
Giovanni Tripepi, Italy
Cecile Couchoud, France
 
 
 
munich
June 25-28 2010, Munich, Germany
 
 
 
logo
October 15 2010, London, UK
 
 
 
logo
The Cardio-Renal Connection
Symposium at
October 16-19 2010, Granada, Spain
 
 
 
Introductory Statement from the Editor in Chief

Welcome Eurecam Members to the second Newsletter. I hope you find the contents interesting and informative. I want to draw your attention to upcoming meetings of course especially the session in Munich at the ERA-EDTA Congress (and the pre-symposium EURECA-M meeting at 16.15, open to all members).

I don't want to start reviewing published papers regularly as part of the Newsletter, but I would welcome discussion on topics raised by important recent papers where this directly impinges on the CardioRenal agenda. I have started the ball rolling. Please email me if you want to with comments for and against what I say. Please also suggest things we can debate internally online (the facility to do these things I hope soon will be made available to us).

Anaemia, CKD, CVD - unravelling the complex inter-relationships

TREAT (1) was a landmark study examining the utility of ESA therapy in patients with moderate CKD and diabetes. The results have been much discussed and debated now (2). Most people agree that this important study shows that the gains in fatigue score for shifting haemoglobin from 10.6 g/dL to 12.5 g/dL using ESAs and IV iron are modest ones, and are offset by an increase in stroke rates, and of course, the huge cost of using ESAs in this way. The idea of more and more ESA for higher and higher Hb targets surely now is finally dead. I hope so. ESAs are complex powerful and expensive drugs, and just because we have become lazy in thinking that more is better, and not addressing reasons for anaemia, nor asking what benefits may flow from treating anaemia, this has meant that more people get ESAs (instead of careful investigation and iron supplementation) than is ideal. The control arm of TREAT with a Hb of 10.6 g/dL was one where about 40% of patients DID get ESA (it was NOT a placebo arm) but the median dose was 2 mcg not 180 mcg of Darbepoietin - saving a huge amount of money. Money is really important now, as many European economies teeter on the abyss of bankruptcy, and we, as responsible European citizens, and doctors, have a responsibility to use the scarce resources we have wisely. Otherwise those resources might disappear.

Its also important to ask what gets better when we increase Hb from 7 to 10 g/dL, and then again, from 10 to 13 g/dL? Most of the symptomatic benefit, and almost all of the cardiac and survival benefits, are achieved by moving from 7 to 10 g/dL. In a recent paper, Kai-Uwe Eckhard and the CREATE co-investigators showed the absence of cardiac benefit comparing a high Hb target arm to a low(er) Hb target arm (3). This goes to show that we need to keep mindful of the real outcomes that matter - patient survival, and not be seduced by surrogates like Hb values themselves. I go into some of these arguments in more detail in a recent review I published in CJASN (4), focussing on rHuEPO in particular. You may absolutely NOT agree with me, and what I say, but its a debate we all need to have now.

Comments at goldsmith@london.com

REFERENCES

(1) Pfeffer M, Burdmann EA, Cooper DE et al. A trial of darbepoetinalfa in type 2 diabetes and chronic kidney disease. N Engl J Med 2009; 361: 1–14

(2) Goldsmtih DJA. Covic A. Time to Reconsider Evidence for Anaemia Treatement (TREAT) - Essential Safety Arguments (ESA). Nephrology Dialysis Transplantation 2010 Jun;25(6):1734-7

(3) Eckardt KU, Scherhag A, Macdougall IC et al. Left ventricular geometry
predicts cardiovascular outcomes associated with anemia correction in CKD. J Am Soc Nephro 2009

(4) Goldsmith D. 2009: a requiem for rHuEPOs--but should we nail down the coffin in 2010? Clin J Am Soc Nephrol. 2010 May;5(5):929-35. Epub 2010 Apr 22

Best wishes

David Goldsmith
Editor in Chief

goldsmith

   David Goldsmith

return to top
 
 
Useful Links and Important Events

European Cardiovascular and Renal Medicine (EURECA-M) Symposium at

XLVII ERA-EDTA Congress / II DGfN Congress

June 25-28 2010, Munich, Germany

munich


5th Annual Scientific Meeting of the Cardiorenal Forum

In association with the Dutch Society of Nephrology and the Netherlands Cardiorenal Group

October 15 2010, London, UK

logo

The Cardio-Renal Connection
Symposium at

XL Congress of the Spanish Society of Nephrology (S.E.N.)

October 16-19 2010, Granada, Spain

logo

News from the German Heart-Kidney Working Group (German only)

The text mentions the start up of a joint working group appointed by the German Society of Cardiology.

The core members of the German Heart-Kidney Working Group are:
Nephrology: Haller (Hannover), Hoyer (Marburg), Rump (Dusseldorf) and Schmieder (Erlangen)
Cardiology: Hoppe (Cologne), Mahfoud (Homburg), Reinicke (Munster), Rauchhaus (Rostock)
Speakers: Rauchhaus, Rump

logo

return to top
 
 
EURECA-m Website: http://www.era-edta.org/eureca-m.htm